Head Injury Guidelines and Assessment: Glasgow Coma Scale

The Glasgow Coma Scale was developed to provide a simple way for health care practitioners of different skill levels and training to quickly assess a patient's mental status and depth of coma based upon observations of eye opening, speech, and movement. Patients in the deepest level of coma:

do not respond with any body movement to pain,

do not have any speech, and

do not open their eyes.

Those in lighter comas may offer some response, to the point they may even seem awake, yet meet the criteria of coma because they do not respond to their environment.

Glasgow Coma Scale

Eye Opening

Spontaneous

4

To loud voice

3

To pain

2

None

1

Verbal Response

Oriented

5

Confused, Disoriented

4

Inappropriate words

3

Incomprehensible words

2

None

1

Motor Response

Obeys commands

6

Localizes pain

5

Withdraws from pain

4

Abnormal flexion posturing

3

Extensor posturing

2

None

1

Glasgow Coma Scale

A person who is awake has a Glasgow Coma Scale of 15, while a person who is dead would have a score of 3. The abnormal motor responses of flexion and extension describe arm and leg movement when a painful stimulus is applied.

The term "decorticate" (de=not + cortex=conscious part of the brain) refers to the cortex of the brain, the part that deals with movement, sensation, and thinking.

"Decerebrate" (de=not + cerebrum= brain and brainstem) means that the cortex and the brain stem that unconsciously controls basic bodily functions like breathing and heart beat, may not functioning.

Trauma patients are often "touched" by many health care practitioners; from first responders, EMTs, emergency physicians, surgeons and neurosurgeons. Not only is it important to assess the depth of coma but also to know if the patient is improving or deteriorating. The Glasgow Coma Scale allows that analysis to occur.

The scale is used as part of the initial evaluation of a patient, but does not assist in making the diagnosis as to the cause of coma. Since it "scores" the level of coma, the GCS can be used as a standard method for any health care practitioner to assess change in patient status.